This project assesses methods for decreasing HIV-risk behaviors in substance abusers, and assesses the safety and efficacy of pharmacological and behavioral treatments for opioid dependence in those already infected with HIV. We have completed a randomized clinical trial examining whether sustained HIV-protective behaviors can be achieved by adding a cognitive-behavioral coping-skills and relapse-prevention intervention to voucher-based contingency management. Inner-city methadone-maintained cocaine abusers were taught: 1) to identify and seek out sources of reinforcement that do not carry risks of HIV, and 2) to develop adaptive problem-focused and emotion-focused coping responses to general and drug-specific stressors that might otherwise trigger HIV-risk behaviors. The study sample (n=81) was 52% female, 70% African American, and 37.9 ? 7.0 years old. There were substantial decreases in HIV-risk behaviors: 49.4% stopped injection drug use, 51.9% stopped sharing needles, 27.2% stopped unprotected sex, and 25.9% stopped trading sex for money or drugs. Participants receiving CBT were more likely to stop unprotected sex relative to controls (OR=5.44, 95% CI 1.14-26.0, p=0.034), but this effect was reduced when adjusted for drug-negative urines. These results suggest broad beneficial effects of methadone maintenance augmented with behavioral interventions for reducing HIV risk behaviors, with limited additional benefit from CBT for reduction of sexual risk behaviors.